Its central deficiency is its “priestly” style,[iii] which leads to –I believe- a Type III error: asking the wrong question[iv]. This is revealed in three passages from the lead article.[v] The first is a laudatory summary of John Holdren’s[vi] position followed by two additional passages:

Holdren highlighted the dilemma the world faces today: reliable and affordable energy is essential for meeting human needs and fueling economic growth (emphasis added), but the world’s current production, distribution, and use of energy is responsible for a series of difficult, damaging, and challenging environmental problems.

In the United States, we should encourage federal funders of research (e.g., National Institutes of Health, Centers for Disease Control and Prevention, Department of Energy, Environmental Protection Agency), industry, and foundations to fund broad-based, interdisciplinary research on the linkages among climate change, energy scarcity, ecosystem degradation, species and biodiversity losses, urban form and transportation systems, and public health.

We urge close collaboration between the Intergovernmental Panel on Climate Change and national and international energy and development institutions (e.g., Department of Energy, International Energy Agency, World Bank, International Monetary Fund).

In the social-empirical world I believe we inhabit, meeting human needs and fueling economic growth is incompatible with the thermodynamic, economic, financial (massive debt, political dominance and corruption) and environmental realities brought to the fore or worsened by peak oil. Nor do I expect corporations, politicians, and governmental and international agencies to hear the clarion call sounded by these earnest academics. These bodies have their underside agendas, as evidenced by their vain attempts to maintain the political/economic/financial status quo peak oil is upending. Bluntly, they evince little or no concern for social responsibility or the public good.[vii]

Thus, the limits to growth, overshoot, any probing discussion of the interdependence of energy/economy and finance, the potential for institutional collapse, and the need to create a sustainable society –based upon an overhaul of consumer society- go unaddressed in this special issue. For all its erudition and genuine concern of its authors, this special issue demonstrates only a ghost of awareness. It is an anachronistic and jejune health policy analysis of peak oil as a “risk” to be “mitigated” within the framework of logical incrementalism,[viii] whereas I find peak oil an epochal reality.

Ignoring these issues is professionally remiss and is best illustrated by the editor’s truncated criticism of ideal-typical economic responses to peak oil. They write:

Classical economic theory predicts that the increases in oil price should have elicited 2 responses–– a decline in world demand and an increase in world production––but neither response occurred to any significant degree.

There is a third response, and we have seen it unfold since 2008: demand destruction, a euphemism for economic decline for which Mr. Market has no timely answer. I propose that discussing demand destruction would require a sober consideration of a worst-case scenario of how peak oil already is inducing socioeconomic collapse/contraction. When it comes to modeling worst-case scenarios for pandemics, public health does not hold back. It is unconscionable that worst-case scenarios for the effects of unstoppable energy decline, likely resulting in “peak health”, receive no such candor.

Eisenstein adumbrates the energy based economic contraction and reduction in social and technological complexity:

The transition before us is not merely a transition in fuel types. It is also a transition in the whole energy infrastructure, both physical and psychological; a transition away from big power plants, distribution lines, and metered consumers; away from capital-intensive drilling, refining, distribution, and consumer fueling stations. More broadly, it is a transition away from centralization, concentration, and all the social institutions that go along with it.[ix]

To this we can add the web of ecological and environmental dilemmas[x], then the phenomenon of “extend and pretend” currently in play in government and finance. And then we must integrate political and economic corruption (licit and illicit), trends in wealth transfer and distribution, no solution to massive unemployment, and politicians touting “austerity” for those at the middle and lower end of the socioeconomic hierarchy while wealthy elites go unscathed. All of these factors are germane to an assessment of how peak oil threatens public health and health care and the larger social fabric it is woven into.[xi]

In summary, the special issue avoids recognizing or even seriously discussing:

The impossibility of maintaining current levels of consumption and complexity.

The connection between peak oil, debt, credit, unemployment and the inevitability of economic contraction we are already well into.

How public health –and health care- can envision protecting the social determinants of health while remaining structurally viable as the world reaches the limits to growth.

Consideration of the scenario –this is a non-trivial possibility- of reaching a systemic tipping point followed by socioeconomic collapse, as discussed by Korowicz[xii] and the German military report on peak oil[xiii].

Accordingly, playing the priestly role obfuscates and compounds error by relying faithfully on government, foundations, and business to acknowledge and then address peak oil. I believe that these major institutions are in critical respects malfunctioning, captured by elite interests[xiv], and therefore in varied ways harming the public interest. Since the federal government (save the military), most corporations, major media and foundations have not acknowledged peak oil thus far,[xv] there is no rationale offered by the special issue editors for why institutional leaders would do so at this time when these institutions are, quite to the contrary, ensconced in the antediluvian belief that finance –not energy- makes the world go round.

The cultural paradigm/episteme within which public health and health care operates cannot solve problems because its master solution –recall the quote above from John Holdren- is to reignite perpetual growth. And a sotto voce corollary is that the current distribution of wealth, status and power -and corruption- is sustainable. As implied above, peak oil, massive debt, and a host of other ecological predicaments and political dilemmas will change this configuration. For example, new jobs, essential to an economically just and politically stable society, can come only from designing a “Small Is Beautiful” localized society -if this is still possible without a die-back (and we have no choice but to act as if it is possible).

My contention, drawn from the sociology of science[xvi], is that academic public health –and even more so, medicine- is sociologically ill-situated to grasp the need for this cultural transformation as an indispensible prerequisite to creating a sustainable health system. It is my view the vast majority of health profession leaders have been improperly socialized -in a context of “bad knowledge”, if you will- to pursue economic growth to prove their self-worth and keep their positions. All but a few function as modern day Sadducees[xvii] and are unprepared for the upheaval and struggles ahead. In short, they are presiding over an unsustainable health system nested in an unsustainable macro-level political/economy.

My commentary thus far has been abrasive, but I feel it needs to be. No matter how small the voice[xviii] of my colleagues and myself, we realize that others continue to join us as the inconceivable and unimaginable consequences of economic contraction/collapse become commonplace and the consequences for health systems obvious.

With that said, we should recognize that peak oil finally has received an imprimatur, from public health’s flagship journal. The potential significance of this event, plus solid insights and analysis from articles in the special issue, opens space to use the prophetic voice to prod –but not beg- those within public health and medicine to join in the bottom-up to creation of a sustainable health system.[xix]

The primary obligation of the prophetic role is to state the obvious: we are in overshoot, facing the limits to growth and all the major institutions we were brought up to count upon to be of aid and sustenance in fact are clutching the values, beliefs and language of growth culture that peak oil negates.

[i] Thanks to Hank Weiss for incisive comments on an earlier draft of this essay.

[ii] It is necessary to acknowledge my co-authorship of one of the articles in this special issue.

[v] Schwartz, Brian, Howard Frumkin, Cindy Parker, Jeremy Hess. “Public Health and Medicine in an Age of Energy Scarcity: The Case of Petroleum.” American Journal of Public Health, September 2011, Vol. 101, No. 9 |

[vi] John Holdren is advisor to President Barack Obama for Science and Technology, Director of the White House Office of Science and Technology Policy, and Co-Chair of the President’s Council of Advisors on Science and Technology.

[x] Climate change, overfishing, dying oceans and coral reefs, potable water scarcities and aquifer depletion, and on and on.

[xi] Put differently, the larger society that supports academic public health research is succumbing to entropy and this special issue is rooted in the moribund incrementalist mode of policy analysis. As socioeconomic activity continues to contract and lose (phantom) accumulated wealth we face the real possibility of an accelerated institutional collapse, including governmental support for academic public health research. Such conclusions, however, remain heretical and disreputable inside the bounds of respectable academic discourse. This logical incrementalist[xi] “reality” of the policy making process was congruent with an expanding economy, where government revenues that support public health practice and academic public health research, though at times constrained, always increased. The ongoing contraction is evidenced in higher education budget cuts, and the reduction in grants for public heath research. Yet a reading of public health literature, such as emails from the American Journal of Public Health and the Association of Schools of Public Health “Friday Letter,” shows that the economic contraction is defined as an anomaly that will end with a return to the former system.

[xii] Korowicz, David. Tipping Point. Near-Term Systemic Implications of a Peak in Global Oil Production. An Outline Review, The Foundation for the Economics of

[xiv] I believe that the vast majority of career government professionals are committed to their calling and ethical; but it is my opinion that the higher ones goes in government organizations the more likely it is that the leadership is either compromised, corrupt or captured.

[xv] Bob Hirsch is on record that the Department of Energy’s reaction to “The Hirsch Report,” was, “no more studies of peak oil.” People close to those who commissioned the report confirmed to me that this is so.

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2 comments

I haven’t read the original papers in full – they’re behind a paywall so I’ll need to order them via my College library – but the extracts you’ve quoted are indeed depressing. It’s clear that some people, even those who have studied peak oil, can’t seem to let go of the “infinite growth” idea.

I have a paper of my own on peak oil and family medicine in Canada, which is under consideration for publication in Canadian Family Physician and is currently bouncing around between editors and reviewers. I’ve tried to deal with the “infinite growth” problem in that, so it will be interesting to see if anyone listens.

Maybe TPTB should be given quill pens, inkwells and hand-made paper to produce their “papers”. That might create the setting for the correct frame of mind.

It has to be remembered that we have so gone so far into technology that there seems to be no turning back, as when a salamander loses its gills and becomes an obligate air-breathing creature. But if we do not find a way back, much of medical knowledge and technology will go extinct / be lost to posterity.

Our dependence on technology is so nearly complete, that one finds electronic thermometers in physician’s offices. “Electronic” implies semiconductors. For those who may be unacquainted with the complexity of semiconductors:From sand to chip – How a CPU (AMD) is made.

And lest one think that only applies to CPUs, much of the same is true of just about anything else electronic:

Imposing a mandate to switch to Electronic Medical Records was wise within the paradigm of a long-term availability of the Internet. But if one considers its complexity, that long-term availability cannot be taken for granted on the downslope from Hubbert’s peak (or should we call it plateau?):

From terrestrial tetrapods we did get aquatic orders including Crocodilia, some Chelonia (viz. the turtles), some Ophida (viz. aquatic snakes), cetaceans (including whales & dolphins). But this occurred over geologic time, and we may not have the time to make the transition out of high-tech medicine without severe disruption and a lot of the information being lost.

While serious thought needs to be given to how to practice medicine (including surgery) without semiconductor technology and the Internet, an effort also needs to be made to save as much as possible of the high-tech medical knowledge in formats that will stand the test of time.